Main Article Content
Abstract
The aim of the study was to optimize management tactics and improve outcomes in patients with acute purulent diseases of the uterus after surgical treatment.
Materials and methods.In the period from 2015 to 2017 in the departments of gynecology in clinical bases of the Department of obstetrics and gynecology with a course of perinatology of the medical faculty of the Medical Institute of the Russian University of Friendship of Peoples was conducted a comprehensive examination and treatment of 150 patients with acute purulent diseases of the uterus.
Results. All patients were operated on urgently laparoscopic access in the volume of unilateral adnexectomy. In the course of the study the majority of the examined patients was observed violation of the microbiome of the vagina. Comparative analysis of the microflora separated from the abdominal cavity and the material from the cervical canal revealed a low level of coincidence of the results of cultural and molecular genetic studies. However the frequency of detection of sexually transmitted infections did not depend on the location of the material intake. The treatment tactics of management of patients offered by us including a number of modern technologies and methods of treatment, allowed to restore reproductive function almost at a quarter of the examined women.
Conclusion. Rational tactics of management of patients with acute purulent diseases of uterus appendages includes: pathogenetic matched preoperative preparation, an adequate volume of surgical interventions with the elimination of the purulent center, using the latest anesthetic techniques and modern complex of postoperative rehabilitation with a personalized selection of antimicrobial and antibiotic therapy.
Keywords
Article Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015; 372(21): 2039-2048. doi: 10.1056/NEJMra1411426
Dukhin AO. Urgent conditions in gynecology. Reproductive potential of Russia: version, conversion: materials of all-Russian. science.-practice. seminar's. Sochi, 5-8 September, 2015. Russian (Духин А.О. Неотложные состояния в гинекологии //Репродуктивный потенциал России: версии конверсии: материалы общерос. науч.-практ. семинара. Сочи, 5-8 сентября, 2015)
Ford GW, Decker CF. Pelvic inflammatory disease. Dis Mon. 2016; 62(8): 301-305. doi: 10.1016/j.disamonth.2016.03.015
Radzinsky VE ed. Antibacterial therapy of inflammatory diseases of the pelvic organs without error and experimentation: a methodological guide for physicians. Radzinsky VE, Kozlov RS, Dukhin AO. M.: StatusPraesens. 2013. 16 p. Russian (Радзинский В.Е., ред. Антибактериальная терапия воспалительных заболеваний органов малого таза без ошибок и экспериментов: методическое руководство для врачей. Радзинский В.Е., Козлов Р.С., Духин А.О. М.: StatusPraesens, 2013. 16 c.)
Nurgalieva EV, Dukhin AO, Gushchin AE. Microbiota of female genital organs in purulent inflammatory diseases of the genitals. Vestnik RUDN. Series: Medicine. 2016; 2: 197-201. Russian (Нургалиева Е.В., Духин А.О., Гущин А.Е. Микробиота женских половых органов при гнойно-воспалительных заболеваниях гениталий //Вестник РУДН. Серия: Медицина. 2016. № 2. С. 197-201)
Yang TK, Chung CJ, Chung SD, Muo CH, Chang CH, Huang CY. Risk of endometrial cancer in women with pelvic inflammatory disease: a nationwide population-based retrospective cohort study. Medicine (Baltimore). 2015; 94(34): e1278. doi: 10.1097/MD.0000000000001278
Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2011 Assisted reproductive technology fertility clinic successrates report. Atlanta: Department of Health and Human Services, 2013 (http://www.cdc.gov/art/pdf/2011-report/ fertility-clinic/art_2011_clinic_report- full.pdf)
Haggerty CL, Totten PA, Tang G, Astete SG, Ferris MJ, Norori J et al. Identification of novel microbes associated with pelvic inflammatory disease and infertility. Sex. Transm. Infect. 2016; 92(6): 441-446. doi: 10.1136/sextrans-2015-052285
Taylor-Robinson D, Jensen JS, Svenstrup H, Stacey CM. Difficulties experienced in defining the microbial cause of pelvic inflammatory disease. Int J STD AIDS. 2012; 23(1): 18-24. doi: 10.1258/ijsa.2011.011066
Puchkov KV, Korennaya VV, Podzolkova NM. Fast track: surgical protocols of accelerated rehabilitation in gynecology. Medical aspects of a woman's health. 2016; 8(105): 59-64. Russian (Пучков К.В., Коренная В.В., Подзолкова Н.М. Fast track: хирургические протоколы ускоренной реабилитации в гинекологии //Медицинские аспекты здоровья женщины. 2016. № 8(105). С. 59-64)
The order of the Ministry of health of the USSR of April 22, 1985 № 535 «On the unification of microbiological (bacteriological) research methods used in clinical diagnostic laboratories of medical institutions». Russian (Приказ Минздрава СССР от 22 апреля 1985 г. № 535 «Об унификации микробиологических (бактериологических) методов исследования, применяемых в клинико-диагностических лабораториях лечебно-профилактических учреждений».) Available at: http://www.clinlabs.ru/document/prikaz-mz-sssr-ot-22041985-g-no-535-ob-unifikacii-mikrobiologicheskih-bakteriologicheskih //
Radzinsky VE, Dukhin AO. Reproductive health of women after surgical treatment of gynecological diseases. M.: Publishing house of PFUR. 2004. 174 p. Russian (Радзинский В.Е., Духин А.О. Репродуктивное здоровье женщин после хирургического лечения гинекологических заболеваний. М.: Изд-во РУДН, 2004. 174 с.)
Eckert LO, Lentz GM. Infections of the lower and upper genital tracts. Vulva, vagina, cervix, toxic shock syndrome, endometritis and salpingitis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL et al. Comprehensive gynecology. 6th ed. Philadelphia: Mosby Elsevier; 2013: 519-559
Lurie S, Asaala H, Harari OS, Golan A, Sadan O. Uterine сervical non-gonococcal and non-chlamydial bacterial flora and its antibiotic sensitivity in women with pelvic inflammatory disease: did it vary over 20 years? Isr. Мed. Assoc. J. 2010; 12(12): 747-750
Kohreidze NA, Kutusheva GF, Pyasetskaya MF. Clinical significance of the study of the conditionally pathogenic flora of the cervical canal in young women with acute inflammation of the uterus appendages. Obstetrics and gynecology. 2014; 5: 62-67. Russian (Кохреидзе Н.А., Кутушева Г.Ф., Пясецкая М.Ф. Клиническое значение исследования условно-патогенной флоры цервикального канала у молодых женщин с острыми воспалениями придатков матки //Акушерство и гинекология. 2014. № 5. С. 62-67)